Long-term non-invasive ventilation in COPD after acute-on-chronic respiratory failure - 02/08/11
, Marie-Kathrin Breyer a , Otto Chris Burghuber a , Eveline Kink b , Kathrin Kirchheiner a , Robab Kohansal a , Ingrid Schmidt a , Sylvia Hartl a, ⁎ 
Corresponding author. Department of Respiratory and Critical Care Medicine, Otto Wagner Spital, Sanatoriumstrasse 2, A-1140, Vienna, Austria. Tel.: +43 1 91060 41006; fax: +43 1 91060 49823.Summary |
Background |
COPD patients who remain hypercapnic after acute respiratory failure requiring mechanical ventilation have a poor prognosis. Long-term nocturnal non-invasive ventilation (NIV) may be beneficial for these patients. We hypothesized that stable patients on long-term NIV would experience clinical worsening after withdrawal of NIV.
Methods |
We included 26 consecutive COPD patients (63 ± 6 years, 58% male, FEV1 31 ± 14% predicted) who remained hypercapnic after acute respiratory failure requiring mechanical ventilation. After a six month run-in period, during which all patients received NIV, they were randomised to either continue (ventilation group, n = 13) or to stop NIV (withdrawal group, n = 13). The primary endpoint was time to clinical worsening defined as an escalation of mechanical ventilation.
Results |
All patients remained stable during the run-in period. After randomisation the withdrawal group had a higher probability of clinical worsening compared to the ventilation group (p = 0.0018). After 12 months, ten patients (77%) in the withdrawal group, but only two patients (15%) in the ventilation group, experienced clinical worsening (p = 0.0048). Six-minute walking distance increased in the ventilation group.
Conclusion |
COPD patients who remain hypercapnic after acute respiratory failure requiring mechanical ventilation may benefit from long-term NIV.
Le texte complet de cet article est disponible en PDF.Keywords : Chronic-obstructive pulmonary disease, Hypercapnia, Intensive care unit, Mechanical ventilation, Prognosis, Respiratory failure
Plan
 | This research was supported by the Ludwig Boltzmann Institute for COPD, Vienna, Austria. |
Vol 105 - N° 3
P. 427-434 - mars 2011 Retour au numéro
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